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HomeMy WebLinkAboutDoherty Concrete; 2018-10-01; PKRC675Project: PKRC675 Picnic Shade Structure Repair at Stagecoach Community Park Change Order No. 1 CITY OF CARLSBAD CONTRACT CHANGE ORDER NO. 1 PROJECT: PKRC675 Picnic Shade Structure Repair at Stagecoach Community Park CONTRACT NO. PKRC675 ACCOUNT NO. 0014610-7550 CONTRACTOR: Charles Doherty Concrete ADDRESS: 2850 Industry Street, Oceanside, CA 92054 P.O. NO. P136530 The Contractor is directed to make the following changes as described herein. Changes shall include all labor, materials, equipment, contract time extension, and all other goods and services required to implement this change. Payment stated on this change order includes all charges, direct or indirect, arising out of this additional work including charges for field overhead, extended home office overhead, delays, disruptions, cumulative impacts, loss of efficiency, extended equipment costs and overtime premium costs and is expressly agreed between the City and the Contractor to be the complete and final costs hereof. The requirements of the specifications, where pertinent and not in conflict with this change order, shall apply to these changes. Pursuant to the Standard Specifications for Public Works Construction, perform the following: Item 1: Increase to contract cost. ........................................................... $10,570.00 TOTAL INCREASE TO CONTRACT COST .............................................. $10,570.00 TIME FOR COMPLETION OF ALL WORK UNDER THIS CONTRACT SHALL BE INCREASED BY ZERO (0) WORKING DAYS BECAUSE OF THIS CHANGE ORDER. Project: PKRC675 Picnic Shade Structure Repair at Stagecoach Community Park Change Order No. 1 RECOMMENDED BY: APPR07t/ ¥ROJECT MANAGER '<oATE) CONTRACTOR Charles Doherty Concrete 2850 Industry Street Oceanside, CA 92054 760-535-9295 cwdoherty@cox.net Estimate ADDRESS SHIPTO MORGAN ROCKDALE SHADE STRUCTURES STAGE COACH COMMUNITY PARK 3420 CAMINO DEL COCH ES CARLSBAD, CA 92009 ESTIMATE# 1232 ACTIVITY DATE 11/29/2018 PROPOSAL FOR ADDITIONAL WORK REQUESTED TO REPLACE DAMAGED/ DRY ROT OF STRUCTURAL MEMBERS AFTER EXPOSING TOPS OF BEAMS IT WAS DISCOVERED (14) ADDITIONAL 4 IN X 12 IN X 24 FT BEAMS NEED TO BE REPLACED. WE PROPOSE TO PROVIDE LABOR AT PREVAILING WAGES AND EQUIPMENT TO REMOVE AND REPLACE THESE DAMAGED BEAMS PER THE SAME TERMS AS PREVIOUS PROPOSAL #1167 3 MEN 4 DAYS (96 HRS)@ $95.00 EQUIPMENT RENTAL-LIFT 4 DAYS@ $250.00 OPTION TO REPLACE EXISTING BOLTS WITH STAINLESS-$450.00 *PRICE INCLUDES PRIMER AND FINISHED PAINT COAT QTY RATE 96 95.00 4 250.00 450.00 AMOUNT 9,120.00 1,000.00 450.00 TOTAL $10,570.00 Accepted By Accepted Date CITY OF CARLSBAD MINOR PUBLIC WORKS CONTRACT PICNIC SHADE STRUCTURE REPAIR AT STAGECOACH COMMUNITY PARK CONT. NO. PKRC675 Tracking#: This agreement is made on the / St day of E)c_;J;-i--;; OA , 20.J.Z by the City of Carlsbad, California, a munidpal corporation, (hereinafter called "City"), and Doherty Concrete whose principal place of business is 2850 Industry Street, Oceanside, CA 92054 (hereinafter called "Contractor"). City and Contractor agree as follows: DESCRIPTION OF WORK. Contractor shall perform all work specified in the Contract documents for the project described by these Contract Documents (hereinafter called "Project"). PROVISIONS OF LABOR AND MATERIALS. Contractor shall provide all labor, materials, tools, equipment, and personnel to perform the work specified by the Contract Documents unless excepted elsewhere in this Contract. CONTRACT DOCUMENTS. The Contract Documents consist of this Contract, exhibits to this Contract, Contractor's Proposal, the Plans and Specifications, the General Provisions, addendum(s) to said Plans and Specifications, and all proper amendments and changes made thereto in accordance with this Contract or the Plans and Specifications, all of which are incorporated herein by this reference. When in conflict, this Contract will supersede terms and conditions in the Contractor's proposal. LABOR. Contractor will employ only skilled workers and abide by all State laws and City of Carlsbad Ordinances governing labor. GUARANTEE. Contractor guarantees all labor and materials furnished and agrees to complete the Project in accordance with directions and subject to inspection approval and acceptance by: Tim Selke (City Project Manager) WAGE RATES. The general prevailing rate of wages for each craft or type of worker needed to execute the Contract shall be those as determined by the Director of Industrial Relations pursuant to Sections 1770, 1773 and 1773.1 of the Labor Code. Pursuant to Section 1773.2 of the Labor Code, a current copy of the applicable wage rates is on file in the Office of the City Engineer. Contractor shall not pay less than the said specified prevailing rates of wages to all workers employed by him or her in execution of the Contract. Contractor shall be responsible for insuring compliance with provisions of section 1777.5 of the Labor Code and section 4100 et seq. of the Public Contracts Code, "Subletting and Subcontracting Fair Practices Act." The City Engineer is the City's "duly authorized officer'' for the purposes of section 4107 and 4107.5. The provisions of Part 7, Chapter 1, of the Labor Code commencing with section 1720 shall apply to the Contract for work. A contractor or subcontractor shall not be qualified to bid on, be listed in a bid proposal, subject to the requirements of Section 4104 of the Public Contract Code, or engage in the performance of any contract for public work, unless currently registered and qualified to perform public work pursuant to Section 1725.5. This project is subject to compliance monitoring and enforcement by the Department of Industrial Relations. Contractor and any subcontractors shall comply with Section 1776 of the California Labor Code, which generally requires keeping accurate payroll records, verifying and certifying payroll records, and making them available for inspection. Contractor shall require any subcontractors to comply with Section 1776. PICNIC SHADE STRUCTURE REPAIR AT STAGECOACH COMMUNITY PARK CONT. NO. PKRC675 Page 1 of6 City Attorney Approved 9/27/2016 Tracking#: FALSE CLAIMS. Contractor hereby agrees that any contract claim submitted to the City must be asserted as part of the contract process as set forth in this agreement and not in anticipation of litigation or in conjunction with litigation. Contractor acknowledges that California Government Code sections 12650 et seq., the False Claims Act, provides for civil penalties where a person knowingly submits a false claim to a public entity. These provisions include false claims made with deliberate ignorance of the false information or in reckless disregard of the truth or falsity of the information. The provisions of Carlsbad Municipal Code sections 3.32.025, 3.32.026, 3.32.027 and 3.32.028 pertaining to false claims are incorporated herein by reference. Contractor hereby acknowledges that the filing of a false claim may subject the Contractor to an administrative debarment proceeding wherein the contractor may be prevented from further bidding on public contracts for a period of up to five years and that debar n y another jurisdiction is grounds for the City of Carlsbad to disqualify the Contractor or subcon participating in contract bidding. Signature: Print Name: REQUIRED INSURANCE. The successful contractor shall provide to the City of Carlsbad, a Certification of Commercial General Liability and Property Damage Insurance and a Certificate of Workers' Compensation Insurance indicating coverage in a form approved by the California Insurance Commission. The certificates shall indicate coverage during the period of the contract and must be furnished to the City prior to the start of work. The minimum limits of liability insurance are to be placed with California admitted insurers that have a current Best's Key Rating of not less than "A-:VII"; OR with a surplus line insurer on the State of California's List of Approved Surplus Line Insurers (LASLI) with a rating in the latest Best's Key Rating Guide of at least "A:X"; OR an alien non-admitted insurer listed by the National Association of Insurance Commissioners (NAIC) latest quarterly listings report. Commercial General Liability Insurance of Injuries including accidental death, to any one person in an amount not less than ........ $1,000,000 Subject to the same limit for each person on account of one accident in an amount not less than ....... $1,000,000 Property damage insurance in an amount of not less than ........ $1,000,000 Automobile Liability Insurance in the amount of $1,000,000 combined single limit per accident for bodily injury and property damage. In addition, the auto policy must cover any vehicle used in the performance of the contract, used onsite or offsite, whether owned, non-owned or hired, and whether scheduled or non- scheduled. The automobile insurance certificate must state the coverage is for "any auto" and cannot be limited in any manner. The above policies shall have non-cancellation clauses providing that thirty (30) days written notice shall be given to the City prior to such cancellation. The policies shall name the City of Carlsbad as an additional insured. The full limits available to the named insured shall also be available and applicable to the City as an additional insured. WORKERS' COMPENSATION AND EMPLOYER'S LIABILITY. Workers' Compensation limits as required by the California Labor Code. Workers' Compensation will not be required if Contractor has no employees and provides, to City's satisfaction, a declaration stating this. BUSINESS LICENSE. The Contractor and all subcontractors are required to have and maintain a valid City of Carlsbad Business License for the duration of the contract. PICNIC SHADE STRUCTURE REPAIR AT STAGECOACH COMMUNITY PARK CONT. NO. PKRC675 Page 2 of6 City Attorney Approved 9/27/2016 Tracking#: INDEMNITY. The Contractor shall assume the defense of, pay all expenses of defense, and indemnify and hold harmless the City, and its officers and employees, from all claims, loss, damage, injury and liability of every kind, nature and description, directly or indirectly arising from or in connection with the performance of the Contract or work; or from any failure or alleged failure of Contractor to comply with any applicable law, rules or regulations including those related to safety and health; and from any and all claims, loss, damages, injury and liability, howsoever the same may be caused, resulting directly or indirectly from the nature of the work covered by the Contract, except for loss or damage caused by the sole or active negligence or willful misconduct of the City. The expenses of defense include all costs and expenses including attorneys' fees for litigation, arbitration, or other dispute resolution method. JURISDICTION. The Contractor agrees and hereby stipulates that the proper venue and jurisdiction for resolution of any disputes between the parties arising out of this agreement is San Diego County, California. Start Work: Contractor agrees to start within 15 working days after receipt of Notice to Proceed. Completion: Contractor agrees to complete work within 45 working days after receipt of Notice to Proceed. CONTRACTOR'S INFORMATION. II II II II II II Doherty Concrete (name of Contractor) 707928 (Contractor's license number) A, C-8, and C-13 / exp. date 6/30/2019 (license class. and exp. date) 1000019050 (DIR registration number) 6/30/2019 (DIR registration exp. date) PICNIC SHADE STRUCTURE REPAIR AT STAGECOACH COMMUNITY PARK CONT. NO. PKRC675 Page 3 of6 2850 Industry Street (street address) Oceanside, CA 92054 ( city/state/zip) 760-535-9295 (telephone no.) (fax no.) cwdoherty@cox.net (e-mail address) City Attorney Approved 9/27/2016 Tracking#: AUTHORITY. The individuals executing this Agreement and the instruments referenced in it on behalf of Contractor each represent and warrant that they have the legal power, right and actual authority to bind Contractor to the terms and conditions of this Agreement. CONTRACTOR By: By: (sign here) (print name/title) CITY OF CARLSBAD, a municipal corporation of the State of California Parks & Recreation Director ATTEST: BARBARA ENGLESON City Clerk If required by City, proper notarial acknowledgment of execution by Contractor must be attached . .!f...g corporation, Agreement must be signed by one corporate officer from each of the following two groups: Group A Chairman, President, or Vice-President Group B Secretary, Assistant Secretary, CFO or Assistant Treasurer Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation. APPROVED AS TO FORM: ::uA A!?/Jlf' r;;mey Assistant City Attorney PICNIC SHADE STRUCTURE REPAIR AT STAGECOACH COMMUNITY PARK CONT. NO. PKRC675 Page 4 of6 City Attorney Approved 9/27/2016 Tracking#: EXHIBIT A LISTING OF SUBCONTRACTORS BY GENERAL CONTRACTOR Set forth below is the full name and location of the place of business of each sub-contractor whom the Contractor proposes to subcontract portions of the Project in excess of one-half of one percent of the total bid, and the portion of the Project which will be done by each sub-contractor for each subcontract. NOTE: The Contractor understands that if it fails to specify a sub-contractor for any portion of the Project to be performed under the contract in excess of one-half of one percent of the bid, the contractor shall be deemed to have agreed to perform such portion, and that the Contractor shall not be permitted to sublet or subcontract that portion of the work, except in cases of public emergency or necessity, and then only after a finding, reduced in writing as a public record of the Awarding Authority, setting forth the facts constituting the emergency or necessity in accordance with the provisions of the Subletting and Subcontracting Fair Practices Act (Section 4100 et seq. of the California Public Contract Code). If no subcontractors are to be employed on the project, enter the word "NONE." SUBCONTRACTORS Portion of Project to Business Name and Address DIR Registration License No., %of be Subcontracted No. Classification & Total Exoiration Date Contract )J'b 'Sv~ S - Total % Subcontracted: -~---'----- The Contractor must perform no less than fifty percent (50%) of the work with its own forces. PICNIC SHADE STRUCTURE REPAIR AT STAGECOACH COMMUNITY PARK CONT. NO. PKRC675 Page 5 of6 City Attorney Approved 9/27/2016 Tracking#: EXHIBIT B SCOPE OF WORK Doherty Concrete (Contractor) will provide labor, equipment, tools and materials (excluding wood) to remove and replace damaged and rotting wood on two picnic shelters at Stagecoach Community Park. All work shall be performed according to the attached proposal dated August 15, 2018. Contractor will: • Remove existing rotten wood • Prime and paint wood to match existing pattern and layout • Install wood • Clean up site and dispose of wood City will provide Contractor only wood to complete the job. Contractor will provide all other supplies such as paint, primer, nails, screws, etc. Agreement amount shall not exceed $22,400.00. PICNIC SHADE STRUCTURE REPAIR AT STAGECOACH COMMUNITY PARK CONT. NO. PKRC675 Page 6 of 6 City Attorney Approved 9/27/2016 Charles Doherty Concrete 2850 Industry Street Oceanside, CA 92054 760-535-9295 cwdoherty@cox.net Estimate ADDRESS SHIP TO MORGAN ROCKDALE STAGE COACH COMMUNITY PARK 3420 CAMINO DEL COCHES CARLSBAD, CA 92009 ESTIMATE# 1167 ACTIVITY *SCOPE OF WORK DATE 08/15/2018 PROVIDE LABOR AT PREVAILING WAGES, EQUIPMENT AND TOOLS TO COMPLETE THE FOLLOWING ITEMS OF WORK TO REPAIR (2) 24 FT X 24 FT SHADE STRUCTURES. NOTE: IT IS UNDERSTOOD THE TOTAL SCOPE OF WORK CANNOT BE RECOGNIZED UNTIL DEMO IS COMPLETED AND A MORE THOROUGH REVIEW OF DAMAGED OR ROTTING WOOD CAN BE DETERMINED. THE FOLLOWING IS A SCOPE OF WORK BASED ON AN ASSUMED TASK. ADDITIONAL WORK AND MATERIALS MAY BE REQUIRED. STRUCTURE #1 1. REMOVE AND DISPOSE OF ALL EXISTING 2 IN X 2 IN LUMBER ON TOP OF EXISTING 4 IN X 12 IN BEAMS REMOVE AND DISPOSE OF A TOT AL OF (6) 24 FT 4 IN X 12 IN BEAMS 2. PRIME AND PAINT (6) NEW (PROVIDED BY CITY) 4 IN X 12 IN X 24 FT BEAMS 3. INSTALL (6) 4 IN X 12 IN BEAMS 4. PRIME AND PAINT PROVIDED 2 IN X 2 IN LUMBER FOR SHADE STRUCTURE 5. INSTALL 2 IN X 2 IN LUMBER FOR SHADE STRUCTURE (MATCH EXISTING DETAILS) STRUCTURE #2 1. REMOVE AND DISPOSE OF ALL EXISTING 2 IN X 2 IN LUMBER ON TOP OF EXISTING 4 IN X 12 IN BEAMS REMOVE AND DISPOSE OF A TOTAL OF (4) 24 FT 4 IN X 12 IN BEAMS 2. PRIME AND PAINT (4) NEW (PROVIDED BY CITY) 4 IN X 12 IN X 24 FT BEAMS 3. INSTALL (4) 4 IN X 12 IN BEAMS 4. PRIME AND PAINT PROVIDED 2 IN X 2 IN LUMBER FOR SHADE STRUCTURE QTY RATE 300 8.00 100 8.00 300 8.00 200 16.00 300 8.00 300 8.00 100 8.00 300 8.00 200 16.00 AMOUNT 2,400.00 800.00 2,400.00 3,200.00 2,400.00 2,400.00 800.00 2,400.00 3,200.00 ACTIVITY 5. INSTALL 2 IN X 2 IN LUMBER FOR SHADE STRUCTURE (MATCH EXISTING DETAILS) *BOND RATE (IF REQUIRED) 3.2% TOTAL Accepted By Accepted Date QTY 300 RATE 8.00 AMOUNT 2,400.00 $22,400.00 ACTIVITY 5. INSTALL 2 IN X 2 IN LUMBER FOR SHADE STRUCTURE (MATCH EXISTING DETAILS) *BOND RATE (IF REQUIRED) 3.2% TOTAL Accepted By Accepted Date QTY 300 RATE 8.00 AMOUNT 2,400.00 $22,400.00 I I ~ CHARDOH-01 KSEBIANE ACORD. CERTIFICATE OF LIABILITY INSURANCE I DATE(IIM/DD/YYYY) ~ 08/01/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BElWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIACATE HOLDER IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License t 0757n& Sffi~CT Carlsbad, CA -MMA -HUB International Insurance Services Inc. r~NJo, Eld): (760) 804--0402 I FAX 2 1525 Faradal Avenue, Suite 200 (A/C Nol: (760) 804-094 Carlsbad, C 92008 ~;!611,_, INSURl=RlSI AFFORDING COVERAGE NAIC II 1NSURER A : Admiral Insurance Comnanv 24856 INSURED INSURER a: Watford Insurance Comoanv 25585 Charles Doherty Concrete INSURER c : National Union Fire Insurance Company of Pittsburgh, PA 19445 Charlie 1302 Crestrldge Dr. INSURERD: Oceanside, CA 92054 INSURERE: INSURERF: COVERAGES CERTIFICATE NUMBER· REVISION NUMBER· THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AU THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE '"1JIJl !IUBR POLICY NUMBER POUCYEFF POUCYEXP LIMITS TD --~~ , .. A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s 1,000,000 , CLAIMS-MADE m OCCUR X ICA000024840--03 07/05/2018 07/15/2019 Q~!M~~I9i=~ENTED s 300,000 X Per Project Agg. -MED EXP (Any one oersonl $ 5,000 1,000,000 PERSONAL & ADV INJURY s ~ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s ~· POLICY O ~f8i O LOC PRODUCTS • COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY ~~~1SINGLE LIMIT $ 1,000,000 - ANY AUTO WIC1001835--00 07/31/2018 07/31/2019 BODILY INJURY (Per oerson\ s -OWNED X SCHEDULED -AUTOS ONLY _ AUTOS BODILY INJURY <Per acxidentl S X ~/NH'soNLY X ~8f''<ivmJt~ r~~JJ,SAMAGE s t--- $ C X UMBRELLA LIAB ~ OCCUR EACH OCCURRENCE $ 2,000,000 t--EBU 06'083224 07/05/2018 07/15/2019 2,000,000 EXCESSLIAB CLAIMS-MADE AGGREGATE s OED I I RETENTION$ Prods/Comp Ops s 2,000,000 WORKERS COIIPENSA TION I ~~fnJTF I jg~-AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE D NIA EL. EACH ACCIDENT $ ~,',a~~~~~~ft~ EXCLUDED? E.L. DISEASE • EA EMPLOYEE $ ~~if~~ of"dPERA TIONS below E.L. DISEASE -POLICY LIMIT $ DESCRJPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Additional Remark• Schedul•, may be attached If_,, ltj)let 19 :a':2~ Certlflc11bl holder 11 named n Addhlon11I Insured with respect to General Liability perform CG2010 0413 & CG 03 0413. CERTIFICATE HOLDER I City of Carlsbad 1635 Faraday Ave Carlsbad, CA 92008-7314 ACORD 25 (2016/03) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUffiORIZED REPRESENTATIVE ~ © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ./ Policy Number: CA000024840-03 CG 20 34 0413 Effective Date: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -LESSOR OF LEASED EQUIPMENT -AUTOMATIC STATUS WHEN REQUIRED IN LEASE AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II -Who Is An Insured is amended to include as an additional insured any person(s) or organization(s) from whom you lease equipment when you and such person(s) or organization(s) have agreed in writing in a contract or agreement that such person(s) or organiza- tion(s) be added as an additional insured on your policy. Such person(s) or organization(s) is an insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person(s) or organi- zation(s). However, the insurance afforded to such additional in- sured: I. Only applies to the extent pennitted by law; and 2. Will not be broader than that which you are required by the contract or agreement to provide for such ad- ditional insured. A person's or organization's status as an additional in- sured under this endorsement ends when their contract or agreement with you for such leased equipment ends. B. With respect to the insurance afforded to these addi- tional insureds, this insurance does not apply to any "occurrence" which takes place after the equipment lease expires. C. With respect to the insurance afforded to these addi- tional insureds, the following is added to Section III - Limits Of Insurance: The most we will pay on behalfofthe additional in- sured is the amount of insurance: 1. Required by the contract or agreement you have entered into with the additional insured; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Lim- its of Insurance shown in the Declarations. CG 20 34 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 a ____, CHARDOH-01 ccnCA"' ACORD~ CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/00/YYYY) ~ 12/07/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lleu of such endorsement(s). PRODUCER Wt!J~CT Paramount Exclusive Insurance Services, Inc. W8,Nrfo Extl: (818) 986-7283 I~. Nol:(818) 986-4949 16000 Ventura Blvd. #200 E~ Encino, CA 91436 I.A' . INSURER/SI AFFORDING COVERAGE NAIC# INSURER A: Benchmark Insurance Co. 41394 INSURED INSURER B: Charles Doherty INSURERC: 1302 Crestrldge Dr. INSURER D: Oceanside, CA 92054 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT Vv'ITH RESPECT TO 1/VHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWII MAY HAVE BEEN REDUCED BY PAID CLAIMS. I~~: TYPE OF INSURANCE ~~.,o~ SUBR POLICY NUMBER POLICYEFF POLICY EXP LIMITS ""'" .... COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s -~ CLAIMS-MADE D OCCUR g~~U9e~NTED -- s MED EXP CAffl one oarson\ --s -PERSONAL & ADV INJURY s GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ Fl POLICY O ~r8r O LOC PRODUCTS -COMP/OP AGG s 01l1ER: $ AUTOMOBILE LIABILITY f-- )i,OMBINED SINGLE LIMIT 'a-rl,ianl\ s ANY AUTO BODILY INJURY !Per ,_.,,.,, $ -OWNED -SCHEDULED -AUTOS ONLY >--AUTOS BOOIL Y INJURY /Per accidentl S -~~'WPsoNLY -~8+-'as"mii~ Ffe?~~"TJ.t?AMAGE s s UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ -EXCESS LIAB CLAIMS-MADE AGGREGATE s DEO I I RETENTION s s A WORKERS COMPENSATION X J ~ffruTE I I ~JH-AND EMPLOYERS' LIABILITY YIN CST5011614 12/05/2017 12/05/2018 1,000,000 mY PROPRIETOR/PARTNER/EXECUTIVE m E.L. EACH ACCIDENT s ~FICERIMEMB~R EXCLUDED? N/A I 1,000,000 andatory In N I E.L. DISEASE -EA EMPLOYEE s ~isMrP¥i~ ~PERATIONS below E.L. DISEASE· POLICY LIMIT $ 1,000,000 1 DESCRIPTION OP OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Addltlonol Remarks Schedule, may ba attached If more apace ls required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Carlsbad THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1635 faraday Ave. ACCORDANCE WITH THE POLICY PROVISIONS. Carlsbad, CA 92008 I J:~r::ps2;;,VE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD